MEDICARE: DR. HETAL V VAIDYA D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019.026860	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821197229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HETAL V VAIDYA D.D.S

Provider Business Mailing Address
First Line	:	CMR 442
Second Line	:	HEIDELBERG DENTAL ACTIVITY CREDENTIALS OFFICE
City	:	APO
State	:	AE
Zip	:	09042
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 W HUBBARD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1474
Country	:	US
Telephone Number	:	614-258-3880
Fax Number	:	614-252-5873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	12/27/2012

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